CMS/EIP Fiscal Report Center: 55
Services beginning 10/01/2015 ending 12/31/2015 Date of Report:02/13/2016 Page: 1
List order: No List
Agency Filter:EXT
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
EVAL-96111-DEVELOPMENTAL EVALUATION 3 3.500000 175.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 3 4.000000 200.0000 50.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 21 41.228700 3092.1300 74.9995
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 18 36.000400 2700.0000 74.9992
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 58 115.000000 8625.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 17 34.000000 1887.0000 55.5000
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 1 1.000000 51.0500 51.0500
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 4 4.000000 204.2000 51.0500
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 2 2.000000 102.1000 51.0500
PSTH-97001-EVAL BY LICENSED PT, INITIAL 6 6.000000 306.3000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 9 9.000000 459.4500 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 113 256.729100 17853.2800 69.5413
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 3 4.000000 1820.8700 455.2175
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 5 3.500000 175.0000 50.0000
CONIF-CONIF-CONSULT, FACE TO FACE 2 4.000000 200.0000 50.0000
CONIP-CONIP-CONSULT, PHONE 20 38.500000 962.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 88 488.500000 24425.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 545 4670.000000 46700.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 131 739.500600 52830.8800 71.4413
OCCT-97530HM-OT SESSION BY OT ASST 43 215.000400 12298.0000 57.1999
PHY-97110-PT SESSION BY LICENSED PT 126 676.500671 48329.1658 71.4399
PHY-97110HM-PT SESSION BY PT ASST 30 122.000000 6973.5200 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 379 2255.752300 161150.7796 71.4399
TRAV-TRAVS-Travel by mile 71 3570.000000 1589.1900 0.4452
Subtotal (Total Children Is Unduplicated) 584 12787.25397 357454.9054 27.9540
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Total 13043.983071 375308.1854 28.7725
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Number of Children (Unduplicated) With at Least One Service 629
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Center 55
Flag Claims Units Chgs Paid
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R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 7438 10255.762512 186950.5100 186950.5400
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
3298 2788.220559 188357.6754 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 10736 13043.983071 375308.1854 186950.5400